Putting ‘you’ back into diagnosis, treatment

Forget allergic reactions and taking countless medications that don’t do what they’re supposed to do. Imagine going to the doctor or pharmacist and getting treatment tailored to your needs, the first time, every time.

The work of Dr. Richard Kim, inaugural Medical Research Chair in Pharmacogenomics at the Schulich School of Medicine & Dentistry, is heading in that direction.

Soon, the concept of personalized medicine by way of pharmacogenomics – treatment customized for a patient based on his/her genetic makeup – could be a reality. And Western University is leading the way.

Kim and his research team are the first in Canada to apply pharmacogenomics research and use related state-of-the-art technologies at the level of patient care.

“We are the first group – I actually think I’m the first physician in the country to start what is called a ‘personalized medicine clinic’ for a couple of medications that are widely used, including the blood thinner Warfarin,” Kim said.

Shortly after the opening of his first clinic in London, he opened up another, focusing efforts on genetic screening for breast cancer patients and survivors who take a drug called Tamoxifen. At the latter clinic, opened only in 2010, his team has worked with close to 200 patients, some who travelled long distances to see him.

Kim explained medications are generally administered with a “one-size-fits-all” approach, with the hope every patient will metabolize them in the same way. Genetic variations mean some people need more, or less, of the same medication to get the desired effect. And some patients might need a different drug altogether to avoid averse reactions.

“Some people need one milligram a day (of Warfarin), others need 15 milligrams a day. If you don’t get the dosing right, you run the risk of over thinning the blood and (the patient) bleeding out; and if you don’t give enough, you don’t get the benefit. By doing (genetic) testing, you can find the right dose ahead of time and you can get started on the right dose, maximize benefit and minimize toxicity,” Kim said.

“Ours is the only clinic that does active genotyping and measures active drug levels. We (apply) research, using state of the art mass spectrometers that can measure very tiny quantities of things and even things viewed as difficult to measure. We apply cutting edge technology and use that toward delivery of better care,” he added.

For Kim, who was recruited in 2006 from Vanderbilt University to serve as the head of the division of Clinical Pharmacology in the Department of Medicine, the new endowed chair position in pharmacogenomics isn’t just an affirmation of a job well done so far; it also brings more support for research going into improving the quality of patient care.

“We have a lot of patients depending on us for innovative patient care and research. We are at the forefront of the best type of patient care.”

Because of an aging population, already high health-care costs will only go up in the future, Kim said, adding pharmacogenomics and approaches to personalized medicine won’t just benefit patients; they will benefit the health-care system as a whole.

“Some of our next goals include the prevention of adverse drug reactions for patients in hospitals and out patient clinics, or even a family medicine setting. This is a huge problem because adverse drug reactions are the fourth leading cause of death in hospitalized patients. The cost of adverse drug reactions is thought to be as much or more than the cost of all the drugs combined,” Kim said.

Last year, the cost of administered medications in Canada was $32 billion, Kim added, a number second only to overall hospital and health-care costs and greater than the whole federal deficit.

“Even if we can make a modest dent in that expenditure, we think it would lead to better patient outcomes in terms of less hospitalization and it could possibly reduce unexpected deaths (from adverse reactions). For sure it would reduce clinic visits and costs to the system. We think that’s another promising frontier for personalized medicine and pharmacogenomics.”

This is why Kim and his team are so grateful for the symbiotic relationships between academic work at the university and clinical patient care in the community at the London Health Sciences Centre.

“Western should be proud of fostering these types of relationships. I view this endowed chair as a sense of affirmation and tangible support to say, ‘We’re with you. Let’s really push this hard and see how far we get,’” he said. “But first, we have to show this is the wave of the future. In the coming years, the funding agencies or the ministry will see the merit of paying for genomic testing and providing the service as cost efficient, one that will be part of standard care.”


Western has set its sights on becoming a world-class leader in research with a goal of creating 100 new endowed chairs by 2020. Five chairs have been created under the program: